Prenatal Mindfulness Training As Primary Prevention of Maternal Anxiety: Reaching Underserved Pregnant Women through Group Medical Visits

Introduction: Maternal anxiety in the prenatal period poses significant developmental risks for children; it is linked with emotional and behavioral problems in early childhood and adolescence. Notably, the adverse effects of prenatal anxiety on child development extend beyond psychosocial well-being to broader indices of physical health including reduced adaptive immunity, and greater risk of asthma and obesity. This evidence underscores prenatal anxiety as a public health concern with long-term implications. Treating anxiety and other mental health problems in pregnancy poses special challenges. Pharmacotherapy can have significant side effects and is resisted by many pregnant women. Traditional psychotherapy is time and resource-intensive and can carry stigma. Mindfulness avoids these limitations and is now established as an evidence-based approach for treating anxiety, supported by randomized controlled trial effects on generalized anxiety and pregnancy-specific anxiety. Unfortunately, access to these programs is severely limited for pregnant women living in poverty and those who are undocumented or who do not speak English.

Methods: The current study involved integrating mindfulness strategies tailored for pregnancy and childbirth preparation into an existing model of group prenatal healthcare: Centering Pregnancy (CP). CP has been shown to reduce risk of preterm birth and is widely disseminated in the U.S. In a quasi-experimental study, we enrolled pregnant women receiving Medicaid covered prenatal care from a public safety net hospital in two forms of CP: standard and mindfulness-enhanced CP delivered in both English- and Spanish-language groups. N=49 women completed three mixed-methods assessments in the 2^nd and 3^rdtrimesters and postpartum.

Results:  Participants were low-income and predominantly minority (48.5% Latina). Initial results (n=38) indicate women receiving CP with mindfulness skills (n=18) experienced a significant reduction in pregnancy-related anxiety from pre- to post-test, from M=2.66 (SD=.65) to M=2.36 (SD=.63); t(17)=2.49, p=.023, and lower trait anxiety (M=35.8, SD=7.81) at post-test compared to the group receiving the standard CP curriculum (M=40.79, SD=9.06), t(37)=-1.85, p=.073. Qualitative interviews revealed that participants in the treatment group commonly reported the mindfulness modules as most helpful for coping with stresses of pregnancy and the early postpartum period.

Conclusions: This study demonstrates that an already efficacious prenatal healthcare intervention may be improved through the addition of mindfulness elements. Capitalizing on an existing model designed to reach low-income, racial/ethnic minority populations holds promise for improving health equity in the domain of maternal prenatal anxiety.